Provider Demographics
NPI:1255940466
Name:KOSTINAS, SARAH (CPNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KOSTINAS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 FARNSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5738
Mailing Address - Country:US
Mailing Address - Phone:757-407-0377
Mailing Address - Fax:
Practice Address - Street 1:1924 LANDSTOWN CENTRE WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1624
Practice Address - Country:US
Practice Address - Phone:757-668-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179739363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics